Auftrags-Nr.: Order no.: ... Date Signature. MA 110 Standard

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1 Zenit Active Wheelchair Auftrags-Nr.: Order no.: Zenit Active wheelchair Article number: 480F160=1_AA01_C Provide estimate only Order Billing address/customer number Delivery address Ottobock Zenit_647F557=EN Technical modifications and printing errors reserved Sales person Equipment Standard equipment Open aluminium tube frame, foldable Choice of front frame offset Foldable leg rest Back upholtery adjustable Aluminium side panels Modular design Rear wheels with quick release axels Knee lever lock 4.0 Calf strap Folding, max. user weight 120 kg MA 110 Standard MA 111 MA 112 Material frame tube CLT version (incl. rear wheel adapter firmly welded, MA 08, MH 05, ME 04, MG 15, MG 200) (available from ) CLT version, Ultra (incl. rear wheel adapter and LL firmly welded, MA 08, MH 05, ME 04, MG 15, MG 200, MC 18, MD 18, MD 50, MD 12) (available from ) MA 08 Aluminium MA 12 Carbon (only with 85 and 2 cm offset) Spring support folding mechanism Name... Date Signature By placing the order, you agree to comply with the instructions for use/service manuals for accessories and products of other manufacturers when combining them with an Ottobock product, in addition to the instructions for use/service manuals of the respective Ottobock products. Also you confirm to have read, understood and accepted, our general terms and conditions. In addition, you agree, upon placing an order, to conduct your own conformity assessment or approval in accordance with national requirements if and when you implement modifications or attachments that do not meet the specifications of Ottobock instructions for use/service manuals. MA 120 Standard X The number codes contained in this order form are not intended to be used as article numbers for spare parts orders. Please use the spare parts catalogue for spare parts orders. Zenit 1/7

2 Front frame angle MA MA Front frame offset MA 14 0 cm offset MA 15 2 cm offset MA 30 2 cm abduction Seat Width Seat depth SD in cm Anterior seat height in cm Frame accessories MA 51 Tip-assist, right MA 52 Tip-assist, left MA 55 Anti-tipper, right MA 56 Anti-tipper, left MA 60 Frame upholstery Caster wheels MF 30 4" solid rubber, black MF 35 4" soft caster, aluminium MF 31 5" solid rubber, black MF 36 5" soft caster, aluminium MF " soft caster, grey MF 05 6" pneumatic MF 32 6" solid rubber, black MF 37 6" soft caster, aluminium Caster axle MF 90 Caster forks with threaded axles Posterior seat height in cm Rear wheel size MG 02 24" MG 00 25" Rear wheel camber Zenit 2/7

3 Rear wheel rim 24" 25" MG 06 Hollow rims MG 10 Spinergy SPOX MG 11 Spinergy LX MG 12 Spinergy LXL Blade, black spokes MG 12 Spinergy LXL Blade, Blade, white spokes MG 15 Infinity Ultralight MG 150 Infinity Ultralight, coloured Colour Package: Infinity Ultralight / Castor Fork 24" 25" Sparkle light orange Marine blue Candy red Sparkle granny-smith MG 22 Topolino WX Carbon Tyres 24" 25" MG 31 Schwalbe RightRun, fine tread, 1" MG 33 Schwalbe DownTown, asymmetrical tread, 1", black MG 34 PU 1" MG 37 Schwalbe Marathon Plus Evolution, 1", puncture-proof MG 200 Schwalbe ONE 1" (available from ) Push rings 24" 25" MG 50 Aluminium, black coated MG 52 Aluminium, silver anodised, high MG 53 Aluminium, silver anodised, low MG 54 Aluminium, rubber-coated MG 56 Stainless steel, polished, high MG 57 Stainless steel, polished, low MG 58 Titanium, polished MG 61 The Surge MG 63 Curve L MG 64 Curve L Grip MX 27 Natural fit, regular grip Zenit 3/7

4 90º Mounting MG 70 Narrow MG 71 Wide Breakover point in cm (measured parallel to the ground) Breakover point Quick-release axle system MG 27 Quick-release axle MG 28 Quick-release axle with Tetra release Rear wheel accessories MG 87 High-pressure air pump, 14 bar MG 88 Airman pump, battery-operated Wheel locks MH 01 Knee lever wheel lock 4.0 MH 05 OutFront scissor wheel lock Wheel lock accessories MH 10 Wheel lock lever extension for knee lever wheel lock Back height in cm Back system MD 01 Back tubes, straight (90 to seat tube) MD 11 Angel adjustable, swing away to seat tubes (-10 /-5 /0 /+5 /+10 ) MD 12 Fixed welded back Back upholstery MD 03 Sewn, adaptable using hook-and-loop straps MD 05 High-frequency welded, adaptable using hook-and-loop straps MD 18 Ultra light MD 06 Without Zenit 4/7

5 Use of BAXX Back system (include order form, model-specific restrictions are possible) MD 44 BAXX Aluminium back, enclosed MP Push handles MD 50 Short MD 51 Long MD 55 Height-adjustable/removable MD 56 Fold-down MD 59 Without Side panels ME 01 Side panel, fixed, with protection against the cold ME 02 Clothing protector, fixed, with protection against the cold ME 04 Clothing protector, fixed, carbon ME 05 Side panel with armrest, short (available from ) ME 06 Side panel with armrest, long (available from ) 5 Lower leg length in cm (without seat cushion) Lower leg length (LL) in cm... (available setting range 28 cm 51 cm) 2 Seat upholstery MC 15 Seat upholstery with storage compartments MC 16 Upholstery readjustable MC 18 Ultra light MC 06 Without Seat cushions MC 01 Seat cushion, standard 3 cm 5 cm MC 02 Cubic Foam seat cushion (thickness 5 cm) MC 05 Evolight seat cushion (thickness 6 cm) MC 09 Contour Gel cushion (wedge shape) MC 20 Terra seat cushion (thickness 10 cm) MC 21 Terra Aquos seat cushion (thickness 10 cm) MC 22 Terra Flair seat cushion (thickness 10 cm) MC 23 Cloud cushion (thickness 10 cm) MC 24 Advantage cushion (thickness 10 cm) MC 25 Z-Flo cushion (thickness 7 cm) Leg support MB 050 Single panel, foldable X Zenit 5/7

6 Design footplate MB 160 Aluminium MB 180 Carbon Other accessories MZ 51 Lap belt with metal buckle MZ 59 Pocket for mobile phone Spoke protectors MG 90 Spoke protector, transparent MG 100 Spoke protector, Graphic decor MG 101 Spoke protector, Miracle decor MG 102 Spoke protector, Network decor MG 103 Spoke protector, Robots decor MG 104 Spoke protector, Spectrum decor Frame colours MA 111/MA Brilliant silver 002 Anthracite metallic 003 Jet black RAL Ice blue 005 Sparkle light orange 009 Vinho sparkle 010 Marine blue 012 Sky blue 013 Jet black RAL 9005 matte 014 Candy red 021 Sparkle granny smith 023 White RAL Shimano matte 039 Black, mat eloxadized 040 Anthrazit, mat eloxadozed 041 Gold, mat eloxadized 042 Blue, mat eloxadized 043 Orange, mat eloxadized 044 Green, mat eloxadized 045 Purple, mat eloxadizead 046 Red, mat eloxadized Special accessories MZ 58 Bag for rear wheels MZ 89 Protection for quick-release-axle MZ 92 Wheel blades MZ 93 Wheelchair backpack Zenit 6/7

7 Information MG 06 Hollow rim MG 10 Spinergy SPOX MG 11 Spinergy LX MG 15 Infinity Ultralight MF 35/36/37 4/5/6" soft caster MG 100 Graphic MG 104 Spectrum Zenit 7/7

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